The presence of intraperitoneal free air signals perforation of a hollow viscus in over 90% of the patients. Rarely, however, the presence of pneumoperitoneum may not indicate an intra-abdominal perforation and thus may not require laparotomy. This condition, which poses a dilemma to the surgeon faced with this problem, is termed "nonsurgical", "spontaneous" or "idiopathic" pneumoperitoneum. Six cases of nonsurgical pneumoperitoneum admitted over a 2-year period to our institution are reported, and the etiological mechanisms and the pathophysiology of the appearance of intra-abdominal free gas are reviewed. Two of the six children with nonsurgical pneumoperitoneum underwent exploratory laparotomy when clinical examination suggested an acute abdomen; no intra-abdominal pathology was documented in one of these patients. In the other children, malrotation was found. Four patients, on ventilatory support, were managed conservatively after performing a diagnostic peritoneal lavage and/or contrast studies those were negative. An appreciation of the condition and its likely etiological factors should improve awareness and possibly reduce the imperative to perform emergency laparotomy on an otherwise well patient with an unexplained pneumoperitoneum.
This article was mistakenly published as a Case Report. In fact, it is an Original Article.
The purpose of medical treatment in the caustic esophageal burns (CEB) is to decrease inflammatory reaction and to prevent stricture formation. Resveratrol has anti-inflammatory and antifibrotic properties. The aim of this study is to investigate potential therapeutic effects of resveratrol in experimental CEB. We divided 42 male Wistar albino rats into five groups: a control group, caustic groups 4 and 28 (esophageal burns were created), and resveratrol groups 4 and 28 (esophageal burns were created and resveratrol was administered). We used 25% NaOH to form CEB following the method of Gehanno and Guedon as modified by Liu and Richardson. Animals were killed on the 4th and 28th days for biochemical and histopathological examinations. We found that the mean malondialdehyde and nitric oxide assays of the caustic groups were significantly higher than that of the resveratrol groups (P < 0.05). On the other hand, glutathione assay of the resveratrol groups was significantly higher than that of the caustic groups (P < 0.05). Histologically, edema, inflammation and necrosis were found to be significantly lower in the resveratrol 4 group compared with the caustic 4 group (P < 0.05). Submucosal and muscular collagen accumulation were found significantly lower in the resveratrol 28 group compared with the caustic 28 group (P < 0.05). We conclude that resveratrol decreased both the inflammatory reaction and the stricture formation in experimental CEB.
Ganglioneuroma are rare, benign neural tumor of sympathetic nervous system originating from neural crest sympathogonia. Pelvic ganglioneuromas may mimic ovarian masses. We present a patient operated with the diagnosis of ovarian tumor which had a pelvic gangliuoneuroma.Case:An eleven-year old female patient complaining of abdominal pain and a mass was seen at our hospital. On examination a 10×10 cm mass was palpable in the pelvis. Laboratory parameters were all normal and the tumor markers such as β-HCG, AFP, CEA, serum catecholamines were negative. Abdominal ultrasonography and computed tomography showed an 11×6×9 cm solid mass containing calcification. The preoperative diagnosis was an adnexal mass of ovary. The patient was operated under general anesthesia and we found a retroperitoneal mass attached to the spine at L5. The tumoral mass was completely excised. Histopathological examination of tumor was reported as ganglioneuroma. The patient was discharged on seventh day of hospitalization with no neurological deficit.Retroperitoneal ganglioneuromas are usually present with local mass a benign tumoral course. The preoperative diagnosis may be difficult in pelvic ganglioneuromas due to close similarity with the ovarian masses. The treatment of the ganglioneuroma is total surgical excision and histology provides a confirmatory diagnosis.
Introduction: We aimed to underline the importance of the covert comorbidities like ileal intestinal polyps in pediatric abdominal operations for appendicitis. Case: A 10-year-old girl was referred to us from the emergency ward with the complaints of abdominal pain and vomiting. After detailed examination, we decided to conduct an abdominal exploration in suspicion of potential acute appendicitis. During the laparotomy, an acute simple appendicitis was found and appendectomy was performed. We further explored the abdomen to rule out a possible Meckel diverticulitis, during which an ileal intraluminal mass was palpated about 10 cm proximal to the intestinal ileocecal valve. We performed enterotomy and resected the polypoid mass completely. The histopathological reports were lymphoid hyperplasia for the appendicitis and intestinal hyperplastic polyp for the polypoid mass. Follow up of the patient after 6 months was eventless. Conclusions: Comorbidities like intestinal polyps should be part of the considerations during the abdominal explorations for acute appendicitis. Missing an ileal polyp may lead to a second operation.
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